 "The She Wolves of Jülich", 1591. Image from Wikipedia. Many have heard about the infamous European witch trials that ironically took place during a time period we call the Renaissance (c.1450-1750). What you may be less familiar with were so-called werewolf trials, in which physicians of the day would play a part. When a person might be accused of being a werewolf, a physician or similarly identified medical expert of the time might be called into the trial to perform a physical examination to look for evidence of a “connection with the devil,” be it a skin mark or something that could erroneously be used against the defendant–whether they were accused of witchcraft or being a werewolf. Contemporary accounts from this time period describe a possible association between mental illness and the belief that one might be a werewolf. Numerous accounts exist describing individuals (even up to the 20th century) that may have expressed a belief that they were wolves, though these accounts are not necessarily suggestive of violent behavior but may include behaviors mimicking those of a wolf. The term for persons diagnosed with a psychiatric syndrome leading them to believe or act as if they are a wolf is called “clinical lycanthropy” and is thought to be very rare. The medical experts that were called upon to weigh-in on werewolf trials would help render an opinion as to whether the person on trial might actually be a werewolf or, more helpfully, might argue a type of insanity defense that attributed the person’s behavior with a mental illness, which could lead to an acquittal. I think we can all agree that court proceedings and medico-legal defense strategies make for dry werewolf fiction. Predatory, full-moon transforming, silver-bullet dodging lycanthropes may be more interesting in their fictional form. Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4090416/#R37 Max Doctor with a mustache.
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As we found in our recent episode, the medical origin story of the zombie seems to have originated in Haiti and associated Caribbean islands with practitioners of voodoo, a religious practice brought to the region by West African slaves, and has nothing to do with the flesh-eating, brains-seeking versions in popular culture. Travelers from the Caribbean during the 19th and 20th centuries told tales about persons who were transformed into living dead servants by evilly dispositioned “bokor,” voodoo practitioners believed to have the capability of creating zombies with special brews or potions. The zombie powders obtained from bokors seemed to always contain ground up puffer fish. This, in turn, contains tetrodotoxin, a substance within the pufferfish capable of causing full paralysis–including breathing–in high enough doses. It appears these powders were typically applied to the skin. Cases of persons claiming to have been declared dead only to be found on the streets years later with personality alterations have persisted into the 20th century. This has led to the theory that use of zombie powder may have induced a level of paralysis that appeared to medical practitioners of the time as consistent with death. Persons may have even been buried for a short time until the tetrodotoxin wore off. If they weren’t buried, they also may not have been breathing adequately if the toxin dose paralyzed the muscles of breathing. These factors may have lead to near asphyxiation and the low oxygen environment of a grave may have contributed to varying degrees of anoxic brain injury, a phenomenon that might explain why some of those purported to be zombies, seemed to be acting off or at least without the mental faculties that their families may have expected. This is all a far cry from the pop culture zombies we see in the media today. Max Doctor with a mustache. Much of the popular mythos of vampirism draws from Bram Stoker’s “Dracula,” a work written after he had done a deep dive on the European folklore of the time on the subject of vampires. Though medical conditions such as rabies, porphyria, and tuberculosis have been suggested as culprits in originating the myth of the vampire, a nutritional deficiency may have been to blame: pellagra. Pellagra occurs when people don’t get enough vitamin B3 (aka niacin). This vitamin is used for many cellular functions. We don’t absorb it well from corn, which became the main food staple for the peasant’s diet in much of Europe in the 18th century as it was imported from America. Pellagra was first recognized as a disease in 1735 and suspected then to be due to nutritional cause. Pellagra is described by the “four D’s”: dermatitis, diarrhea, dementia, and death. Dermatitis refers to skin inflammation and rash that can occur with exposure to sunlight with pellagra–easy to make that connection to vampires. Without niacin, neurons can degenerate leading to dementia and, curiously, a behavior called “pica”. Pica is the strong craving for non-food substances including dirt and ice and other unusual things. It’s been suggested that this may result in the apparent unusual cravings of the vampire. Severe pellagra can result in death. Notably, the vampire cannon seems to leave out the diarrhea aspect of this disorder. That’s probably a good thing. Journal Article: https://journals.sagepub.com/doi/pdf/10.1177/014107689709001114 Max Doctor with a mustache. Digitalis In 1785, an English physician, Dr. William Withering, published his account of experimentation with a collection of herbs he’d received from a witch. This stemmed from a patient he’d had who he was treating for “dropsy”, an old tyme term for edema or fluid under the skin, typically attributed to something we know today as congestive heart failure (CHF). Whether it is weakened by a heart attack, a viral infection, or many years of pumping against high blood pressure, a heart may start to pump inefficiently. Instead of moving blood around the body in a nice, orderly fashion, the blood backs up as it fails to move forward as well as it used to. This leads to the fluid part of the blood leaking out into areas like the legs (especially thanks to gravity) and the lungs, leading to the shortness of breath and fatigue that is associated with CHF. So when the 18th century doctor had his patient show up appearing to be improved from a mysterious plant mixture given to him by a supposed witch, the doctor was curious and visited her. He was given a sample of foxglove and pursued testing of it for many years before publishing the account. He gave it to 160 of his own patients with various conditions and noted it seemed to improve the dropsy. He described an active ingredient called digitalis that foxglove and many other plants contain. Today we know this medication as “digoxin” and it is still used to treat CHF in select cases. Digoxin affects the shifting of electrolytes into and out of heart cells with an overall effect of improving the pumping strength of the heart. This helps people move their blood through the kidneys and clear out all that edema. It’s a treatment but not a cure for CHF. Mind you that digoxin can be dangerous in toxic doses. Starting with nausea, poor appetite, and vision problems, high doses can cause kidney issues, dangerous electrolyte levels, and cardiac arrest. Nevertheless, Dr. Withering was keen to listen to the supposed witch in the woods who’d helped his patient and he ultimately helped legitimize–along with others–the use of this seemingly magical medicinal substance. Max Doctor with a mustache. Among the treatments that were recommended by witches (or those who may be accused of witchcraft in Europe dating back to the middle ages), one might find preparations of willow bark and/or leaves. The association between these parts of the willow tree and pain relief were made well beforehand–dating back to perhaps Mesopotamia, the ancient Egyptians, ancient Greeks, and Native Americans, to name a few. Many cultures noted that this plant had seemingly magical properties. Within the leaves and bark of the willow plant (and some others), it contains a type of molecule called a salicylate. By itself, it can decrease inflammation and swelling, thereby aiding in pain relief and decreasing fever. If you’re the type of person who likes to mix chemicals and do reactions, you might have been Felix Hoffman, a German chemist who is ultimately (though with some controversy) credited with combining salicylic acid with acetic acid while he was working at Bayer in 1897. This created acetylsalicylic acid which we know as Aspirin. In this more refined form, that willow derivative functions as a much better anti-swelling and anti-pain medication. It also happens to stop platelets–a portion of the blood that helps form clots–from clumping together. This led to its still continuing role as a cardiovascular medication. If clots aren’t bunching up in narrow arteries, one might expect fewer heart attacks or strokes to occur. Here we have another modern medication with part of its roots in the apothecary cabinet of your friendly, neighborhood medieval witch. Much better than the leeches and purging agents your medieval doctor may have recommended since the willow bark actually worked, after all. Max Doctor with a mustache. Everyone may be familiar with the concept of witches flying about on a broomstick and whatnot. One association between witchcraft and gravity-averse ability came about with the idea of so-called “flying ointments.” These were unguents (new favorite word) or ointments that contained a mixture of different plant materials which had all sorts of interesting potential. There was not a uniform recipe. These ointments might contain varying amounts of plants such as mandrake, henbane, deadly nightshade, and the Socratic favorite, hemlock. Other substances might be mentioned in recipes, including things like opium. One thing in common with the non-opium substances mentioned is that they all contain what are called “tropane alkaloids.” These alkaloids, whether ingested, inhaled, or, in the case of ointments, absorbed through the skin, could certainly make one think they were mid-flight if the doses were high enough. These substances affect the autonomic nervous system–the part of that system responsible for helping regulate the heart rate, pupil size, digestive system activity, increasing or decreasing blood flow to certain areas of the body, controlling one’s bladder, and even regulating the more interesting bodily functions such as sexual intercourse or vomiting. Too many tropane alkaloids and one can find themselves with a racing heart rate, high body temperature, agitation, and, important to the “flying” bit, in a hallucinatory stupor. Death can result as well. The ointments might be applied to certain areas of the skin or coated on a broomstick or similar wooden staff which could be held, allowing the alkaloids to cross the skin into the bloodstream. Cool bit is that many modern medications derive from these alkaloids, including scopolamine (for motion sickness, dizziness), hyocyamine (for abdominal discomfort and diarrhea), and even atropine (speed up slow hearts, reverse certain nerve gas or pesticide toxicity, dilate eyes for the eye doctor). Maybe it wasn’t magic, but it probably seemed close enough given the understanding of the natural world that the 12th-19th century peoples had. Max Doctor with a mustache. When he was standing on the gallows prior to his execution in October of 1892, Dr. Thomas Neill Cream (aka Dr. Neill or the Lambeth Poisoner), a serial killer and poisoner, started his last words with “I am Jack the . . .” and then he was hung for murder in England before he could finish the sentence. Nevertheless this led to speculation that he might have been the infamous Jack the Ripper, and it wasn’t the first time he’d called that name into his legal proceedings. It took way too long to put Dr. Neill away. A year before his execution, an inquest was called by the coroner in the death of Matilda Clover, a 27 year old sex worker that was found dead after a night with Dr. Neill. This was initially dubbed a “natural” death due to alcohol withdrawal. A prominent physician in London, named Dr. William Broadbent, received a letter soon after Matilda’s death stating the writer knew she was murdered by Broadbent and would keep quiet for £25k. Dr. Broadbent was innocent but following the deaths of many other sex workers on Lambeth street, other weathy members of the community were receiving letters accusing them of murder, complete with details of each crime. Hence the coroner called the inquest to re-examine the cause of death. He found it to be strychnine poisoning. Dr. Neill chose to show up at the inquest and produced a letter which he read aloud. It stated that he, Dr. Neill is innocent, and was signed by “Jack the Ripper.” Weird flex since nobody asked Dr. Neill to show up and the letter was obviously a ridiculous forgery. Considering that before all of this, Dr. Neill was imprisoned in Joliet Prison in Illinois, USA during the years of the Ripper killings, it seems unlikely that Dr. Neill, a murderer in his own right, was being truthful with his last words. Go figure. Max Doctor with a mustache.  Strychnine This commonly referenced poison came up in our most recent episode about Thomas Neil Cream, the Lambeth Poisoner. Strychnine is a naturally occurring product in the seeds of the Strychnos nux-vomica plant. Charming name! Initially used as a rodent and bird poison, it’s not surprising that strychnine is very toxic to humans as well. As a poison, strychnine has a peculiar mechanism of action that is similar to how the toxin from the tetanus bacteria works. In the connection between our nerve endings and our muscles (the synaptic gap), when we want to contract a muscle, the chemical acetylcholine is sprinkled from the nerve to the muscle, causing contraction. Other inhibiting substances, such as glycine, are released to help stop muscle contractions. Strychnine stops the inhibiting substances from working, causing uncontrolled muscle contraction in high enough doses. If this happens, one cannot breathe which is the predominant cause of death with this poison. It can also cause metabolic disturbances and muscle breakdown (rhabdomyolysis) as well as seizure-like activity. All that is bad, medically speaking. Though he used other substances, such as chloroform, strychnine was a favorite go-to choice for the late 19th century serial killer/physician, Dr. Thomas Neill Cream. He would either prescribe it under false pretenses or convince people to take it, causing numerous deaths in multiple countries. Image: https://www.wired.com/2012/01/the-science-of-mysteries/ Max Doctor with a mustache. Kuru is a neurodegenerative disease that was observed to occur among indigenous peoples in Papua New Guinea in the South Pacific. Many of these tribes practiced forms of ritualistic cannibalism and researchers in the early to mid 20th century noticed a peculiar set of neurological problems developing among these people These included movement disorders, unusual behaviors (such as inappropriate laughing fits), difficult walking, and rapidly progressive and ultimately deadly dementia. A virologist, named Daniel Carleton Gajdusek, and an accompanying medical doctor, Vincent Zigas, started looking into the disease in 1957. They initially thought it was a genetic disorder. In 1967, researchers formed the hypothesis that the disease may have been linked to ritualistic cannibalism. The practice was banned by the Australian government overseeing Papua New Guinea at the time and the incidence of kuru was decreasing, further lending credibility to the link between eating human tissue and spread of this disorder. Improving upon his earlier work, Gajdusek found that exposing a chimpanzee to the brain tissue from a deceased tribes-person who died from kuru, led to the development of the disease in that same chimpanzee, years later. Though the transmitting agent was not understood, Gajdusek won a Nobel Prize in Physiology or Medicine in 1976 for demonstrating that kuru could be transmitted–thus showing it was not a genetic condition. In the 1960’s and 1970’s, researchers made the association with the appearance of brain tissue affected by kuru to those found in other unusual diseases such as scrapie–a neurodegenerative condition seen in sheep and goats. This led to the suspicion that the diseases were linked or at least spread in a similar way. Research seemingly excluded other infectious agents–such as bacteria or viruses–as being the cause of these types of diseases. In 1982, neurologist and biochemist Stanley B. Prusiner purified what appeared to be an infectious protein molecule at the University of California, San Francisco. This was a landmark discovery that added the term “prion” to the medical lexicon. The word comes from a combination of “protein” and “infection.” He later won a Nobel Prize in 1997 for this work. Prions are fascinating and terrifying. They are single proteins that are folded or configured in such a way that they cause normal similar proteins to change shape to mimic the prion’s structure. This causes those normal proteins not only to malfunction, but to cause neighboring proteins to change in similar fashion. This seems to particularly affect neurologic tissues and many now identified prion diseases–such as kuru–share characteristics of causing rapid neurologic damage over time. Unlike bacteria or viruses, prions do not hold or need genetic material to replicate themselves. Prions can exist in the environment for years. Normal disinfectants and hygienic procedures do not get rid of prions. Diseases caused by prions are often called “transmissible spongiform encephalopathies.” Spongiform refers to the appearance of brain tissue under a microscope as damaged or sponge-like with holes. Encephalopathy refers to a condition impairing brain function. Though many people may not have heard of kuru or scrapie, Mad Cow Disease may be the most recognizable prion disorder in popular knowledge. Research is ongoing to discover a treatment or cure for these diseases. To date, there is none and prion diseases are fatal. As frightening as this all sounds, the good news is that these diseases are very rare. The most common prion disease in humans in the U.S. is called Creutzfeldt-Jakob disease and even it is a one-in-a-million diagnosis. Look forward to an episode in the near future on a similarly fascinating topic. Stay tuned! Sources: -https://en.wikipedia.org/wiki/Kuru_(disease) -https://www.cdc.gov/prions/cjd/index.html -Kuru, The First Human Prion Disease: https://www.mdpi.com/1999-4915/11/3/232/htm Images: -Chimpanzee Brain with kuru: Courtesy of D. Carleton Gajdusek via https://www.mdpi.com/1999-4915/11/3/232/htm -Dr. Carleton Gajdusek: Courtesy of D. Carleton Gajdusek via https://www.mdpi.com/1999-4915/11/3/232/htm -Histology slides with kuru-infected brain tissue: https://www.sciencedirect.com/topics/nursing-and-health-professions/kuru MaxDoctor with a mustache. Treatment of carbon monoxide poisoning 100 years ago. Courtesy of the American Journal of Public Health (NY) 1922 Apr; 12(4): 355-358. The authors “insist on the vital importance of eliminating carbon monoxide poisoning from the blood as rapidly as possible.” This is absolutely still the treatment 100 years later–albeit with more nuance these days. They then recommended the use of a Tissot army face mask (think gas mask) delivering oxygen from a gas tank and doing so for at least 3 hours. While this would be reasonable treatment even by today’s standards, they did have some odd items recommended. Later the article suggested the patient “should be kept quiet for fear of heart failure for some time after recovery.” Reasonable enough until you add the next line calling for the use of “stimulants.” If you are worried about heart failure, it is best to avoid whipping the heart with stimulants. Carbon monoxide (CO) is an odorless gas that is quite deadly. It comes from the combustion of natural gas and as a byproduct of combustion in a car engine–among other sources. Hemoglobin is the protein within our red blood cells that carries oxygen around the bloodstream. Imagine a globby protein molecule grabbing an oxygen molecule and wandering about the body to give that oxygen to an organ in need. The problem is that hemoglobin loves carbon monoxide even more than oxygen. When the environment contains high levels of CO gas, our hemoglobin will grab and hang onto the CO more tightly–so-to-speak–than it does oxygen. Our bodies can’t use CO the same way we use oxygen so when CO levels in the blood are rising, our oxygen levels are decreasing. Initially mild symptoms such as headache or fatigue can progress to brain or heart damage if not death if someone is exposed to high enough levels for a long enough period of time. So the treatment is to flood the body with as much oxygen as possible so that, even though the hemoglobin loves to hang onto CO, oxygen is so abundant that eventually it replaces the CO molecules being held in the red blood cells. One of the main differences in treatment these days includes improved methods of oxygen delivery. We now have oxygen masks that can deliver much higher concentrations than old masks. Additionally we use hyperbaric oxygen treatments for some CO poisoning cases. This involves putting a patient into a high pressure super-oxygen rich environment to further speed the elimination of CO from the hemoglobin in the bloodstream. The faster the CO is gone, the more likely long term consequences are likely avoided. So here we have a case where the old treatment is still good. Now, it’s just a bit more refined and better understood with the benefit of the past 100 years of research. #histmed #medicalhistory #medicalfacts #carbonmonoxide #occupationalhealth Max Doctor with a mustache. |
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